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HomeMy WebLinkAbout0153 SEA VIEW AVENUE a o �'�� �, � ��'I ��. ,� ,� ,� . ,�, .� t „; _. _.� oFtME rd Town of Barnstable �VE`oPMe/v o 1• Planning& Development Department -`,��FQ Barnstable Historical Commission `�`\ 9�3 BARNSTABLE, 200 Main Street,Hyannis, Massachusetts 02601 n 12 9gj39; `0� (508)862-4787 Fax(508)862-4784 'off %` 1 Mptl°i erin.loran@town.barnstable.ma.us "OFBARNSSP Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Cheryl Powell Frances Parks Jack Kay 9 NAR'21 PM2:i5 BARNSTABLE TOWN CLERK DECISION Summary: Demolition Delay Not Imposed Pursuant to Chapter 112 Historic Properties, Section 112-3 F, 1J G DUILDIN . EPT Applicant/Property Owner: McWilliams,Dean&Andrea MAR 16 2021 Subject Property: 153 Sea View Avenue,Osterville Assessor's Map/Parcel: 162/023/000 TOWN OF Hearing Date: February 16,2021 BARNSTABLE Pursuant to the Barnstable Historical Commission receiving your notice of intent on January 19, 2021, a duly advertised and noticed public hearing was held on February 16, 2021 to determine whether the significant structure identified as a single family home on this property is a preferably preserved significant building and whether demolition delay would be imposed for the partial demolition of the single family structure and full demolition of the shed structure on the parcel addressed as 153 Sea View Avenue,Osterville. After review and consideration of public testimony, application and record file, the Commission by a unanimous vote in favor,found that in accordance with Chapter 112F the partial demolition of the single family structure and full demolition of the shed structure are not preferably preserved significant buildings. In accordance with Chapter 112-3 F, the Commission determined, by a unanimous vote in favor, that the partial demolition of the single family structure and full demolition of the shed structure would not be detrimental to the historical,cultural or architectural heritage or resources of the Town. This decision includes the addition of two mullion lights over the sliders on the rear of the house. This decision applies only to the demolition described in the notice of intent submitted on January 19, 2021. No future demolition shall be permitted without application and approval from the Barnstable Historical Commission. Members present and voting on this application were: Nancy Clark, Marilyn Fifield,Cheryl Powell, Frances Parks, Jack Kay Nancy Clark,Chair I cc: Brian Florence, Building Commissioner Ann Quirk,Town Clerk �1 �FTHE t Town of Barnstable �vE�oPMfNr ��. Planning& Development Department �9 Barnstable Historical Commission SARNSTABLE, 200 Main Street, Hyannis, Massachusetts 02601 9� 1679. 10� (508)862-4787 Fax(508)862-4784 ,O ��� ArFp Mpl a erin.loean@town.barnstable.ma.us `rNOF 8ARNss" Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Cheryl Powell Frances Parks Jack Kay,Alternate at Ar�N HAIFI_E I ►v�N;CLERK February 5, 2021 oFPT2021; ¢� Piio 59 FEE °8 2021 TOWAIOFE Re: Notice of Intent to Demolish Structure & Relocate gRn/s 153 Sea View Avenue, Osterville, Map 162, Parcel 023 Attorney Michael Schulz 134 Main Street Osterville, MA 02655 Ann Quirk,Town Clerk 367 Main Street, Hyannis, MA 02601 Brian Florence, Building Commissioner 200 Main Street, Hyannis, MA 02601 Pursuant to the attached decision, please be advised that the Barnstable Historical Commission will hold a public hearing on the partial demolition of the single family structure on February 16, 2021 at 4:00pm. This meeting will be held remote via Zoom Meeting and can be accessed at https://zoom.usA/98861941788 or by calling the toll-free number 888-475- 4499, meeting I.D. 988 6194 1788. This public hearing will be advertised, notices sent to abutters and a notice form will be posted on the building or other visible site on the property. Please contact Erin Logan at 508.862.4787 or erin.logan@town.barnstable.ma.us for processing information. Sincerely, Nancy Clark, Chair Planning&Development Department-Elizabeth Jenkins,Director Town of Barnstable JE.%.oPME" Pao t T�q. Planning & Development Department �01 raF, Barnstable Historical Commission * BARNSTABLE, * 200 Main Street, Hyannis, Massachusetts 02601 5 1639. � (508)862-4787 Fax(508)862-4784 ATFD MA'S A erin.loran@town.barnstable.ma.us OF 9ARO`'S Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Cheryl Powell Frances Parks Jack Kay Chapter 112 Historic Properties, Section 112-3 D. '-'ARNE)TABLE TOWN CLERK DETERMINATION of SIGNIFICANT BUILDING 153 Sea View Avenue, Osterville, Map 162, Parcel 023 �021 F B'Pi,055 Pursuant to Intent to Demolish Structure The property located at 153 Sea View Avenue, Osterville, Map 162, Parcel 023, is associated with the broad architectural and cultural history of this area. In accordance with Chapters 112-2 and 112-3 (D), the Barnstable Historical Commission Chair has determined that this structure is a significant building. This determination applies only to the demolition described in the notice of intent submitted on January 19, 2021. Any future demolition shall require a new determination from the Barnstable Historical Commission. MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392.6108.FAX(8001851-8424 5/3/2017 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.36 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET HYANNIS MA 02601 CD Cr_ m Re: Insured: STEPHEN J HEALEY IV,ELIZABETH H BALDINI Property Address: 153 SEA VIEW AVE,OSTERVILLE,MA 02655 Policy Number: 0623401 . �Type Loss: Water Damage:Plumbing Systems- rn Date of Loss: 04/26/2017 Claim Number: 414319 Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division CMA00021 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION z Map � �Parcel :?2 Permit# �� q Health Division Date Issued dl'�®—o�D�� Conservation- ivision ON Fee o1 yTax Collector°- �\ c xTreasurer C' /�v Z�� Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis _ Project Street Address A-c-"-e Village 654cnv r Ile Met Owner D 2 . SJLV -eti 4 'ss r Telephone Permit Request S � _ 3O Square feet: 1 st floor: exi ting proposed 2nd floor:existing proposed Total new Estimated Project Cost gaod Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family bW Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes O No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name- FRIAGER CONSTRUCTION Telephone Number Address 71 TARAGON CIR. License# COTU9T MA 02635 Home Improvement Contractor# r/aS�-� Worker's Compensation# A. -13)S yea 3 0 Q,8K ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO l�/Idrf'G SIGNATURE DATE 8 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. r. ADDRESS VILLAGE _r OWNER DATE OF INSPECTOR". FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ` I t -� L s , . _ . . . . . . . i flown fieiv� ur��ca o��/ a�auQel,�a HOME IMPROVEMENT CONTRACTORS REGISTRATION oard of Building Regulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 112536 Expiratio-n 04/06/01 - - Type - DBA HOME IMPROVERENT CONTRACTOR FRASER CONSTRUCTION co Registration 112536 _ DEAN C . FRASER �° Type DBA 71 TARRAGON CIR ElPtration------- --- ------ - - COTUIT MA 02635 - FRASER CONSTROCTION co ' DEAN C. FRASER ARRA60N CIR ADMUMMD wiwIT HA 02635 • The CommohWA*b of b dWWAUUW Dp�rntslet of�Aacfdsnta Id"m Wool 600 wwhbgpn&wd l�ot�oe,11 OL 02111 Worimn' Lwe+u�AHldanit u." R ONSTRUCTION 71 T QON CIR. hmg ten Iana homoomff �� I am a sole haw no 0 0 [am as employ for� as thb fob. f car— •�f Y,• .. . .. 8) 428•2202 t am a ide off'•or hosoeosiw(&d#&vq aLd tm bind the Gaon h ad below who have �rkes: - ........ the tbuowit� ' w A ' adidgm • v. 146 ^ tti W;;':'. '., .,fir•''; ,`y} ' z„x' :::.i:: , � ': �:�v n : .hs ':'' •.d:iy yiy�jMo. ..fit.�..:,Y+.... �i:.�<q�i'�+,� :v•+�� "�Y•' •.f:Y. v:l}.;�:. " . •'V �: 1,i ti:: .Vrl ♦W :r�•t,..• •,M 3}7.' ' " ;ZyOd ��'v.. �: .. .t' +d K":'+ , �+• ,r� :A.:LAftCSidrtfA •w h. rir/K+Ir 3fJ►.rMOL 1/i orlrito dr I��d�•`e�r!�•�•air�al1 �� /rie�wa • rdwAe�efa�l'OZagAp�p oidmanotno m dqo[�� t erm awyomn'tigttrw� d� OlReootott#oA1At�roowroM eop ottl���4 M . I do Jiarij dos%umm.m'ne �PwJ�J'�� �r�einrts a�adaernet - Y oNc�l�wMb done lmddl Wl§I UMIWdbrb'wo=oWd dq►.rawu p dW*uteWA@at.r . soft DNPNMW he Town of Barnstable _ , Depa� ent of Health Safety and LnvirO nmental Services - Building Division 367 Main Street.Hyatmia MA U601 Ralph Crosson ce: 508.862-4038 %nding'Commissioner 508-790-6230 permit no. Data g 0-0AFFIDAVIT HOME IIV11'ROVEN!>ENT CONTRACTOR LAW. SUPPLEMENT TO PERMT AMACATION t>sod ceaversion, MGL c. 14ZA requires the" �+8herado� mm IJIY� oOeUpl� unprovement,removal, molition,or consatdM ftg ob or to WhM are adjacent to building containing at one but not mote then fog �� �Wg�other such residence or building be done by registered requirements. Type of Work: Address of Work: Owner's Name: Date of Application: oz7 I hereby certify that: Regisamion is n t required for the following teaso"(sy [3Work excluded by law [3Job Under S1,000 Building not owner oompied pOwner pugbtg 0 "permit Nodes is hereby given OWNERS PULLING EIR OWN PERMiT ORDEo 1N�WOE NOT HAVE CONTRACTORS FOR PPLICA13LE HOME ACCESS TO THE TION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY 1 hereby apply for a perm as the agent of the owner. g CTD on No. Contn►mr Name Regimad OR s Na Date Owner' me q:fbnns:Atfldav Engineering Dept. (3rd floor) Map i G vZ Parcel Y-1 Permit# 4- House# /S Date Issued — g " 9 S Board of Health(3rd floor)(8:15 -9:30/1:00-4:50)�(7 Fee Conservation Office(4th floor)(8:30-9:30/1:00-2:00) C . Planning Dept.(1st floor/School Admin. Bldg.) S ;fC ���•a- : nee: BE . � . Definitive Plan Approved by Planning Board 19 INST'ALLE 4ri fANCE �P S TOWN OF BARNSTABLEP`"�T�� '� � 'E° DE AND e•'e a7 �.ira� Building Permit Application Project Street Address 16-,q �snd V "qy�F ,q- Village ey Owner 5 r�pi V /Y j;:�'�Z-5 Y Address Telephone `,op Permit Request 946,t:!LL ��C�G`�o� Y 1�r��.� yo X 5;57, I OYa � a�l� xnze to 67are'o © First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 20 0 O Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use �" y Builder Information Name�gjye_ � /yIGL`S 141G a Telephone Number 461 Z -J�Z Z— Ov,Y Z Address�`d'� License# k* 91F,r010d' 111W. 7 7, Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PER IT DENIED FOR THE FOLLOWING REASON(S) 1 k X 1. 8' S c FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. f ADDRESS VILLAGE OWNERI J • - DATE OF INSPECTION: FOUNDATION - FRAME INSULATION - - FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ' ROUGH FINAL FINAL BUILDING b L DATE CLOSED OUT ASSOCIATION PLAN NO. Certif irate' of nee Reqtqt Anto y p�sTe,Q REGISTERED Date.Work Performed �•'°"`''•, APPLICATION issuEa BY s' CONCERN No. GRANITEVILLE COMPANY �yw+�������•'o= GRANITEVILLE SC F RElf F-76. 2 2/12/97 803-663-7231 This is to certify that the materials described on the reverse side hereof have been flame- retardant treated (or are inherently nonflamable).• • FOR ASTRUP COMPANY 'AT 2937 WEST 25th STREET CITY CLEVELAND STATE OHIO 44113 Certification is hereby made that: (Check "a" or"b") (a) The articles described on the reverse side of this Certificate have been treated with a flame- retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used Chem. Reg. No. ' r Method of application [X� (b) The articles described on the reverse side hereof are made from a flame-resistant fabric or material registered and approved by the State Fire Marshal for such use. Trade name of flame-resistant fabric or material used GALA TENTAGE Reg. No. F-76. 2 The flame Retardant Process Used 'WILL NOT Be. Removed By Washing (will or will not) T. L. COLEMAN By J. GR I CE KEEL, GC SUPERVISOR Name of Production Superintendent Tine We hereby certify this to be a true coppy of the original"CERTIFICATE OF FLAME RESISTANCE" issued to us, "original copy" of which has been filed with the California State Fire Marshal. The ASTRUP COMPANY By Control/lot# Quantity 3007. 000` YD . yEITH TENTAGE GALA 51817 31IN WHITE Customer order # Description 390506 768427 Astrup Invoice * Product Code - G'�sP���G=l'L'��S JESSE G. WILLIS 586 PLEASANT ST � � ,a sJf�� ` f= �pA-) WATERTOWN MA 02172-2408 ®N e f • • ' 1�i'll`'r'I►�Yll�i' •Y `i�l�'I►v11Q' Y i1 1 IlTfllv11v1 ` ` IYII�'111�11'� �" Y IYIIv11P �' Y11Y'11Y1 Y ' 1Y11YIIY 11 V11' Certif irate of ame Re'51"!5tance { p�sTF,p REGISTERED Date Work Performed �•'`"`•o, APPLICATION issuED BY c : 2 CONCERN No. GRANITEVILLE. COMPANY . � � • GI-~ANTTEVILLE Sc .I F REl F-76.2 10/31/96 ,! 803-663-7231 This is to certify that the materials described on the reverse side hereof have been flame- retardant treated (or are inherently nonflamable). FOR ASTRUP COMPANY AT 2937 WEST 25th STREET CITY CLEVELAND STATE OHIO 44113 Certification is hereby made that: (Check "a" or"b") ❑ (a) The articles described on the reverse side of this Certificate have been treated with a flame- retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire-Marshal. Name of chemical used Chem. Reg. No. Method of application FX-1 (b) The articles described on the reverse side hereof are made from aflame-resistant fabric or i material registered and approved by the State Fire Marshal for such use. Trade name of flame-resistant fabric or material used GALA TENTAGE Reg. No. F-76'2 The flame Retardant Process Used WILL NOT Be Removed By Washing (will or will not) T. L. COLEMAN By J. GRICE KEELoOC SUPERVISOR Name of Production Superintendent Title We hereby certify this to be a true copy of the original"CERTIFICATE OF FLAME RESISTANCE" issued to us, "original copy" of which has been filed with the California State Fire Marshal. The ASTRUP COMPANY By 1209,000 YD Control/lot# Quantity KEITH TENTAGE,GALA 51817 31IN WHITE Customer order # Description 326654 768427 Astrup Invoice # Product Code ,JESSE r. WILLIS ' 596 PLEASANT ST WATERTOWN- MA 02172-2408 : •. The.011111 tls ;,_t� '= . _=-�•z: "Departluc�.Ifllltdr�strial:4cctde�rts., .., 11-A a" Street � �` Boston,'MUSS. U2111•. . Workers"Compensation lnsurancO Afrdavit �^M, �,�,.,�.�_......-•_ Keith B. Wauters ' Jesse'G. •Willis :Inc.' 586 Pleasant St. locnition- Watertown, MA- ! am a homeowner in itll;work p S. Y.:. p l am a sole proprietor and have no oiie,workinban tiny capacity w ...-•rz�--�_^_ -•-'•- L=-=-==1 � employees worl.ing on thisjob. •~ ® l am an employer providing workers''.compensation for my Jesse G,. Willis,: Inc. nm v : • . . iddr ,t . 586 Pleasant'St. \.. Watertown' MA • 61-7-527-0037 ITT HARTFORD INSURANCE.'CO: 02 -WB CB6578 L......�.r++—••- p 1 am a sole proprietor.general contractor,or homeowner(circle one)and have hired the contractors listed below who eve the followin; workers' compensation!polices: nm an\' n.1mc- iddress, Cit- 'n Cur:1n ..i. .rx.•v�r.`G:,•+-.!;TF�:i'u�♦—�".'�\t+'+'i+�i'T�: rr�.:! ....;•s: 'F?;�1';'�'!.'..`!L"'r•�=^c�''r. nm an\• name: cilv- nol • ��—� ���F.J/.•�•{w �h•.1_►Kll l.'� ♦ •• /.r. I� Y• il7�+Y• M. �y�ylMM ••M1.wTi 6i 'Attach additid'n&J'sheet if tiocessa 111 r'•w� ^�.:,T.'T..r.-rK•��� ' Failure iu secure curera�c iis.requtred undcr.Sccdoq 35A of bSG1.152 eaa Iced to the impositloa or criminal penalties o!a tine up to Sl,$OU.UU and/or one cars'imprisonment as.►ell as civil penalties to the form of a STOp.%VoRX ORDER and s'tlne of Sloo.00 a day against me. 1 understand that a copy.of tliis statenlctJt may be forwarded to the O11Ice ollayestlptlotu of the D.IA for coverage veritlesdoa. r::' /;i J do ltrrebr c �•urtcler.11r�pa rtsaJid�urali�cs,oJfAe♦r�u !!ialJlielr{rornwtlon prodded abovtlstrota�rd correct. y� . ate. Sianature �// hone 0 Print name oRcial use only do nut%►•rite is this area to be completed by city or town official permit/licetue 1l r'tlluilding Dcpaftuicnt city or town: CILiccusing Huard :• : C3Scieetmea•s Office O check itimmediate response b required.'.' :;;'� C311eailb Department n contact person: s P.one.q: Otber �, tined]•n/►JAI i Assessor's Office(1st floor) Map p a Lot b Permit Conservation Office(4th floor) - -' Date Issued l r Board of Health(3rd floor)(8:30-9:30 0:00-2:00) 1 * Fee /Engineering Dept.'(3rd floor) House#1 : /S ,C�tG/yj w Planning Dept.(1st floor/School Admin.Bldg.) - ?� BARN8TABLE, • , Definitive Plan A owed by Planning Board 19 MA e TOWN OF--BARNSTABLE r Building Permit Application Project Street Address Village Owner Address ' .Telephone � Permit Request Total 1 Story Area(include 1 story garages&decks) \ square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? I Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name �Q,�rJ (' r=/t�� Telephone Number Address 7 License# Home Improvement Contractor# Worker's Compensation# ,2a jjI yY NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. �7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO %mil h� 9 xsz SIGNATURE DATE D S BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE'ISSUED MAP/PARCEL'NO. ADDRESS VILLAGE OWNER y DATE OF INSPECTION: ~, i FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL , FINAL BUILDING i t DATE CLOSED OUT ASSOCIATION PLAN NO. '. : The`Town =of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508 790-6227 Ralph Cr0s= Fa)c 508 775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,.removal, demolition, or construction of an addition to any pre-ea� owner occupied building containing at least one but not more than four dwelling units or to structures which art adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: 4a� Est Cost--?� Address of Work: l S—P At- Owner.Name:. OR Lie- — Date of Permit Application:_ I herein,certify that: Registration is not required for the following reason(s): Work occluded by law Job under S1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGIS ORED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor name Registration No. OR Date Owner's name The Commonwealth of Afassachusetts Department of Industrial Accidents office ollnrest/gal/offs 600 Washington Street Boston. Mass. (12111 Workers' Compensation Insurance Affidavit A�ollcant Information:, Please PR11VT legibly se , name: D, - locationo -'7/ -/-7,97�Q22 �n 61y nhonc# V,—� I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 1,:...t r „Fa"?'T.adr7_ i ee... �! {�T.as`••' ..'iS:T. ,..:..':c ..',T•' ...fly!ae+^r'.!v.�7•i^Ytn.•n+..o.;2y�r. am an emplover providing workers' compensation for my employees working on this job. ompanv name: address: - 5CA--1, city: 7tici1 - nhonc#• insurance co. vv'� policy# •t'cJ� ,'�• 6 �� 0 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: .... ........... ........... .. comnan•name address city: phone#: insurance co. policy# company name: address: cit•• phone#• •-insurance co. policy# Attachadditionalsheettfnecessa �r ��F ::=�•-=R►� ' E1,lure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to SI.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of SI00.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herehr ce the pains o talties of erjuq'that the information provided above is true and correct. Si_nature -�'�— Date G&ZZ7 Print name I -e—e-GJ Phone# official use only do not write in this area to be compacted by city or town official city or town: permit/license# Building Department Licensing hoard check if immediate response is required OSelectmen's Office �licalth Ucpartmcnt ' :< contact person: phone#; nUther 4 Y (revised 3195 P1A) , information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an e►nploree is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An einplurer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a•joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. .�t;..'X'>{ \_.rS.rs' r•.:'_"Y . :ar ... Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. r^_�-i:-YR.`-+T�1RSR"ai�T /'C�>T'i:.�^•:I-'�^Nf'4^I[=T+s�q .'.4.y11 CND.a• r+cMr i '!'+'i"r??'y '�+?l4Si.•kRt✓ �.. . y. _.. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. 4,7 . ... y y:� `^rrv' .y: � Y, di.u1�•`.1 _..�:,. :.-...tea+•-'.: ��e-: .M E The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 i� _ .5 .•�,.4 r a JX•.- �o�}�'�kiF� �t-�=trfgt2.. ��y`�r ���V•'4 tlibv+. rY''2 �:��+,r.5 i�. F6 �awl �..� ,,y, r�)�?��Y�'��'.. Gff7e � actweaM _ .. /J .��" r�`lq_ �vX t. �4'a�+t �..-,.. f •' i.r� _. IrrH°'1',< t L�'��f',v� + .ay �il � ti r F� ��Yz'�a�, �r �,�n a � Y. :� ,•:> ,•�. �, ,q�j,4,.: .;, ,�ti�,���v=.e,,, +1, ;.4 '. s i' r3�"' t `�' 1��.�, $ S ? o' +.r a'�!._-,�q. 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